Evidence based implementation of complex interventions

doi:10.1136/bmj.b3124

Published 12 August 2009, doi:10.1136/bmj.b3124
Cite this as: BMJ 2009;339:b3124

Editorials

Evidence based implementation of complex interventions

Multi-method evaluation and high quality reporting are essential

The first 150 words of the full text of this article appear below.

The Ottawa ankle rules can reduce unnecessary radiographs inpatients with ankle injury; two controlled before and aftertrials showed benefit—they reduced radiographs by 26%and 28%, with no adverse consequences.¹ The rules have beendescribed as "a safe, cost effective, and reliable approachto assessing injured ankles with impressive consistency."² Giventhis, surely all staff in all emergency departments should beusing these rules. This is not the case, however—surveyshave shown variable uptake. Furthermore, even when the rulesare promoted within a service with a carefully developed implementationplan, as described by Bessen and colleagues in the linked qualityimprovement report (doi:10.1136/bmj.b3056), the effect seemsmodest.³ Why should this be?

Recognition of the problems of implementation is not new—itis hard enough for drugs with proved efficacy, yet alone complexinterventions such as the Ottawa ankle rules. Although we needevidence to tell us which interventions . . . [Full text of this article]

Richard Thomson, professor of epidemiology and public health

¹ Institute of Health and Society, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4HH

richard.thomson@newcastle.ac.uk

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